Healthcare Provider Details

I. General information

NPI: 1649215732
Provider Name (Legal Business Name): LANCE ROBERT BEHM D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 ELK DR STE 1
MINOT ND
58701
US

IV. Provider business mailing address

2615 ELK DR STE 1
MINOT ND
58701-1200
US

V. Phone/Fax

Practice location:
  • Phone: 701-839-4440
  • Fax: 701-839-1911
Mailing address:
  • Phone: 701-839-4440
  • Fax: 701-839-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1918
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1451163
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: